Shift durations of 12 hours or more are now ubiquitous in hospitals, with currently working staff nurses reporting satisfaction with this shift length, although others who prefer shorter work hours have generally left hospital nursing. Nurse administrators are beginning to question the wisdom of having nurses work extended hours. In part 1 of this 2-part series, the authors provide an update on recent findings that challenge the current scheduling paradigm that supports unsafe long work hours. Part 2 discusses obstacles that nurse administrators face when they "buck the 12-hour trend" and offers guidance for introducing work schedule changes.
"Trinkoff et al.  demonstrated an increase in musculoskeletal disorders of the neck, back and shoulders in their longitudinal study of nurses commencing shifts of 13 hours or longer. This appeared to be related to the increase in physical stress, as the study adjusted for psychological demands and evidence of the detrimental effects of 12 hour shifts on nurses’ health and quality of patient care appears to be growing . Theatre nurses in one study identified prolonged standing and walking (up to 10 hrs) as the main contributing factor to foot/ankle MSDs in their work location . "
[Show abstract][Hide abstract] ABSTRACT: Background
Nurses are at high risk of musculoskeletal disorders (MSDs). Although the prevalence of MSDs of the lower back, upper limbs, neck and shoulders have been reported previously in nursing, few studies have evaluated MSDs of the foot and ankle. This study evaluated the prevalence of foot and ankle MSDs in nurses and their relation to individual and workplace risk factors.
A self-administered survey incorporating the Nordic Musculoskeletal Questionnaire (NMQ) was distributed, over a nine-week period, to all eligible nurses (n = 416) working in a paediatric hospital in Brisbane, Australia. The prevalence of MSDs for each of the NMQ body regions was determined. Bivariate and multivariable logistic regression analyses were conducted to examine the relationships between activity-limiting foot/ankle MSDs and risk factors related to the individual (age, body mass index, number of existing foot conditions, smoking history, general physical health [SF36 Physical Component Scale], footwear features) or the workplace (level of nursing position, work location, average hours worked, hours worked in previous week, time since last break from work).
A 73% response rate was achieved with 304 nurses completing surveys, of whom 276 were females (91%). Mean age of the nurses was 37 years (±10), younger than the state average of 43 years. Foot/ankle MSDs were the most prevalent conditions experienced by nurses during the preceding seven days (43.8%, 95% CI 38.2-49.4%), the second most prevalent MSDs to impair physical activity (16.7%, 95% CI 13.0-21.3%), and the third most prevalent MSD, after lower-back and neck problems, during the preceding 12 months (55.3%, 95% CI 49.6-60.7%). Of the nurse and work characteristics investigated, obesity, poor general physical health, existing foot conditions and working in the intensive care unit emerged as statistically significant (p < 0.05) independent risk factors for activity-limiting foot/ankle MSDs.
Foot/ankle MSDs are common in paediatric hospital nurses and resulted in physical activity limitations in one out of every six nurses. We recommend targeted education programs regarding the prevention, self-management and treatment strategies for foot/ankle MSDs. Further research is needed into the impact of work location and extended shift durations on foot/ankle MSDs.
"Identifying whether workloads exceed the physiological limits is imperative to the determination of workload allocation and shift scheduling (Saha et al, 2008). Furthermore, there are increasing concerns regarding the negative effects of twelve hour shifts upon nurses' wellbeing and work performance (Trinkoff et al, 2006; Keller, 2009; Geiger-Brown and Trinkoff, 2010). In addition, it is recognised that there is an ageing workforce and some studies state that high work pace, demanding physical workload and personal health conditions were the major work challenges for older nurses (Andrews et al, 2005; Chiu et al, 2007; Cameron et al, 2009) and older nurses favour working 8-hour rather than 12- hour shifts (Hoffman and Scott, 2003; Trinkoff et al, 2006). "
[Show abstract][Hide abstract] ABSTRACT: As competition for clinical sites increases, hospitals and nursing schools report the use of nontraditional student placements such as one 12-hour clinical shift; that was an option offered by the author's school. The author discusses implementation of 12-hour shifts and compared NCLEX fail rates of students on one 12-hour shift with students who had 2 weekly 6-hour shifts.
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